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Adductor Tendinopathy
From WikiSM
Contents
Other Names
- Adductor Tendinosis
- Adductor Tendinitis
- Adductor Tendonitis
- Adductor paratenonitis
- Adductor enthesopathy
Background
- This page refers to chronic injuries of the Adductor Muscles
- Acute injuries are discussed separately: Adductor Strain
History
Epidemiology
- Most of the epidemiology focuses on "groin injuries" and does not distinguish etiologies, which can be challenging
- Injuries in the groin area [1]
- Occur between 2% and 7% in athletes
- Are as high as 12%–13% in soccer players
- There is a male predominance
Pathophysiology
- Athletes may have an acute injury or strain that fails to resolve
- Adductor magnus is most commonly implicated
Etiology
- Common in sports that involve repeated kicking, rapid change of direction
- Leads to repetitive microtrauma
- Overstretching may precipitate pathology
- Sudden increase in training type or intensity
Pathoanatomy
- Adductor Complex
- Primary adductor muscle group
- Includes: Adductor Brevis, Adductor Longus, Adductor Magnus
- Responsible for majority of adduction of the thigh
- Closed chain activation: stabilize pelvis, lower extremity during gait
- Adductor magnus can provide some internal rotation; adductor longus can help extend the hip
- Muscles with some adduction activity
Associated Conditions
Risk Factors
- Sports
- Soccer
- Rugby
- Australian Rules football
- Hockey
- American football
- Horse riding
- Gymnastics
- Swimming
- Musculoskeletal
- Inadequate abdominal strength
- Lack of flexibility of posterior chain[2]
- Leg Length Discrepancy
- Strength imbalance
- Lumbar hyperlordosis
- Sacroiliac, sacrolumbar and hip arthropathy
- Defects of plantar support
- Marked asymmetry and/or dysmetry of lower limbs
- Extrinsic risk factors
- Incorrect training
- Unsuitable footwear
- Unfavorable training conditions
Differential Diagnosis
Differential Diagnosis Thigh Pain
- Fractures
- Muscle and Tendon
- Neurological
- Other
Differential Diagnosis Groin Pain
- Muscle And Tendon
- Adductor Tendonitis
- Adductor Strain
- Hip Flexor Tendonitis
- Snapping Hip Syndrome
- Rectus Femoris Strain
- Rectus Abdominus Strain
- Myositis Ossificans
- Sports Hernia
- Hip Etiology
- Acetabular Labrum Tear
- Femoral Acetabular Impingement
- Avulsion Fractures
- Avascular Necrosis of the Hip
- Acetabular Labrum Tear
- Ligamentum Teres Injury
- Osteochondritis Dissecans
- Pelvic Stress Fracture
- Neuropathies
- Ilioinguinal Nerve Injury
- Genitofemoral Nerve Injury
- Iliohypogastric Nerve Injury
- Obturator Nerve Injury
- Meralgia Paresthetica (Lateral Femoral Cutaneous Nerve)
- Spine
- Pelvis
- Athletica Pubalgia
- Osteitis Pubis
- Inguinal Hernia
- Femoral Hernia
- Sports Hernia
- Pediatric Considerations
- Genitourinary & Reproductive
- Ovarian or testicular torsion
- Nephrolithiasis
- Epididymo Orchitis
- Ovarian Cyst
- Pelvic Inflammatory Disease
- Urinary Tract Infection
- Endometriosis
- Prostatitis
- Gastrointestinal
- Appendicitis
- Diverticulitis
- Lymphadenitis
- Inflammatory Bowel Disease
Clinical Features
- History
- Patient will complain of medial thigh or groin pain
- There may have been an acute injury previously, but often insidious in nature
- They may also endorse hip pain, stiffness
- Physical Exam
- Pain with passive abduction
- There may be pinpoint tenderness, often at the tendinous insertion
- They may have weak adduction
- Special Tests
Evaluation
Small calcifications at the pubic symphysis suggesting adductor tendinopathy[3]
Radiographs
- Standard Radiographs Pelvis, consider Standard Radiographs Hip
- Need AP view, frog leg view
- Typically normal, rarely will demonstrate bony enthesiophytes
- Useful to exclude other pathology
MRI
- Findings
- Edema at the site of injury
- Often at the attachment of the adductor longus to the body of the pubis
- If enthesopathy, will show periostitis and adjacent marrow edema
Ultrasound
- Can visualize majority of structures
- Identify area, extend of injury
- Serial examinations during recovery phase
Classification
- N/A
Management
Prognosis
Nonoperative
- Cessation of all activity
- NSAIDS
- Physical Therapy
- Targeting core muscles
- Eccentric exercises on adductor muscle group
- Stretching
- Tendon recovery procedures
- Laser Therapy
- Diathermy (heat therapy)
- Extracorporeal Shock Wave Therapy
- Injections
Operative
- Indications
- Failure of conservative measures
- Technique
- Adductor open tenotomy
- Adductor percutaneus tenotomy
Rehab and Return to Play
Rehabilitation
- When patient is relatively pain free[4]
- Begin progressive range of motion
- Strengthening exercises
- Acute phase
- Postural balance techniques through global and site specific stretching
- Mechanical and proprioceptive orthotic insoles
- Global postural reeducation (RPG)
- Subacute phase
- Muscle strengthening is increased by the introduction of concentric and eccentric exercises
- Cardiovascular reconditioning in the gym or in a therapeutic swimming pool
- Core stability
Return to Play
- Aerobic running with increasing speed
- Gradually short but intense anaerobic training
- Stretching and repeated exercises
- Gradually, exercises with sprints and jumps
- Athletes begin to practice again with the ball
- Finally one-on-one tackles and training matches
Complications
- Chronic Pain
- Inability to return to sport
See Also
References
- ↑ Ekstrand J, Hilding J. The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports. 1999:98–103.
- ↑ Bouvard M, Dorochenko P, Lanusse P, Duraffour H. La pubalgie du sportif, stratégie thérapeutique. J Traumatol Sport. 2004:146–163
- ↑ Bancroft, Laura W., and Donna G. Blankenbaker. "Imaging of the tendons about the pelvis." American Journal of Roentgenology 195.3 (2010): 605-617.
- ↑ Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. 2001;29:521–533
Created by:
John Kiel on 11 June 2019 01:50:21
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Last edited:
28 September 2021 22:40:32
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